`Permanent cosmetics' may pose health risks

By Beth Greenberg, Globe Correspondent, 9/9/2003

Ever wonder how Liz Taylor always manages to have perfect eye makeup? Her eyes have been been permanently lined and her eyebrows filled in. The same technology can now ink five o'clock shadow onto men's scalps to conceal baldness, help reconstructed breasts look more natural, and dye burn marks and scars so they blend in better.

"Permanent cosmetics" -- basically a fancy name for tattoos -- have grown in popularity over the past decade as a substitute for the tedium of applying daily makeup and to compensate for medical problems. But, while many referrals for the procedures are from top-flight doctors and hospitals, the tattoos are generally applied to extremely sensitive areas, like the face, scalp or breast -- and they don't always work as planned.

"A line messed up in a decorative tattoo can be called creative expression. But, if you mess up an eyebrow, it can be disastrous," said Pati Pavlik, education advisor for the Society of Permanent Cosmetics Professionals, a nonprofit advocacy group, and a tattoo artist for 20 years.

With few regulations regarding who can be a tattoo artist and no regulations on what goes into the dyes they use, both artists and doctors are concerned about the permanent unhappiness that can come with permanent ink.

"There's always been an underground, the people who don't have much or any training," said Kat Nelson, a tattoo artist and former aesthetician based in Seabrook, N.H. "You have a lot of people who are racking up their experience on unsuspecting victims."

Nelson, like many practitioners, works closely with a plastic surgeon to create paramedical tattoos for breast reconstructions and face-lift scars. She recently created new eyebrows for her 86-year-old mother after cataracts robbed her of the ability to apply liner.

Shahla Whitmore, a cosmetic tattoo artist based in Newton Centre, said she finds it rewarding to be able to help people regain a sense of independence or feel better about themselves.

"Part of why I'm doing this is the emotional effect it has on the patients. They get more confidence," said Whitmore, who has performed more than 700 procedures in the last three years since tattooing became legal again in Massachusetts.

One 52-year-old North Shore resident who has battled breast cancer for seven years said she's pleased with the tattooing that made her reconstructed breast look more realistic.

"If I'm looking in the mirror I'm not mourning the loss of my breast," said the woman who asked not to be named. "It's not perfect, but when I see myself, it's balanced and it looks pretty good. When I'm changing in the locker room, I don't think people even notice; they don't stare. I think it's a good thing."

Dr. Victor Neel, director of dermatologic surgery at Massachusetts General Hospital, often sees the mistakes and disappointments of permanent cosmetics.

"Some of the dyes create immune problems," he said. "You can provoke systemic allergic reactions. Local skin reactions, eczema, chronic scarring problems, possible joint problems; those chemicals are depositing in the joints. Some are plant dyes, some are weird metallic dyes. They're foreign bodies, basically."

Neel also said he is concerned that, under certain circumstances, clients are not primed for the possibility of failure. "For people who get scar camouflage, the problem is it never looks like real skin. There's no way you can really match skin throughout the year. People end up looking quilt-like."

And if a decision is made to remove the tattoo by laser, the only option other than surgically removing the tattooed skin, some dyes darken rather than lighten. If titanium dioxide, for example, is present in the dye -- and there's no way of knowing until it's exposed to laser -- red dye will turn black. Thus, removing permanent lip color or blush can leave a patient with black lips or cheeks. Neel's suggestion for those considering any type of tattoo: "We sort of recommend that people don't get them."

For individuals who do choose permanent cosmetics, professionals in the field strongly encourage finding an experienced artist, viewing portfolios of her or his work, and absolutely not looking for the cheapest job.

"Isn't it crazy," Pavlik said, "that you need 200 hours of training to file nails legally, but to put needles in people's eyes, you don't need anything?"

The Pulse Points column is on Page F4.